The patient could present with passing frank red blood in the stools, vomit blood, or come with severe weakness as a result of severe anemia.
EMS:
IV line
IV Fluids
EKG
Oxygen
Upper GI Bleeding:
ER:
Routine labs
2 Large bore IV lines
IV Fluids
NG Tube aspiration
Type and Cross match at least 2 units
FFP and/or Vitamin K if high INR
PRBC Transfusion
PPI IV Bolus (Protonix 80mg IV bolus and then drip 8mg/hr OR PPI IV bid.
If patient is unstable, admit to ICU
Hospitalist:
Telemetry
Bed rest if very weak and dizzy
IV Fluids-NS if blood pressure on low side. If patient is very anemic, avoid too much IV fluids as it can worsen anemia and cause cardiac events.
NPO
PPI IV
H/H every 2-6hrs depending on severity of bleeding
PRBC transfusion if severe anemia. [If patient is a ‘Jehovah’s Witness’ with symptomatic acute or anemia, you can’t give PRBC transfusion. In such cases, you may have to give Folic acid, vitamin B12, Epoetin [Procrit], IV or Iron with vitamin C for better absorption etc to improve Hb.]
Octreotide bolus followed by drip if continuous bleeding from variceal bleeding
Platelet transfusion if low platelets
Hold offending medications-ASA, Plavix, Coumadin, NSAIDS, Newer anticoagulants
GI Evaluation:
EGD
Bleeding scan, if positive–> IR consult for possible embolization or Surgery consult for surgery
Lower
GI Bleeding:
Colon preparation and colonoscopy
